Medical Tourism Background
Over the last few decades, the tendency to travel to less developed countries of the world to get a wide range of medical services has gained significant popularity. The sector of medical tourism has turned into a huge industry, which is constantly expanding. People travel to India, Thailand, Singapore, and other countries to undergo a variety of medical procedures including cosmetic surgery, dental care, elective surgery, and fertility treatment. Tourists are attracted mostly by an opportunity to get an effective medical treatment for a reasonable price, and to enjoy the tourist attractions of the country they have chosen as their destination.
The intent to choose India as a favorable place for getting treatment can be explained by a number of factors. They include low cost of medical procedures, high quality of healthcare, excellent tourist products, and the ability to combine treatment with leisure. The continuous flow of medical tourists brings considerable financial income for the government and the private sector. However, the rapid growth of medical treatment industry in India has not only positive but also negative impact on the country’s economy. Thus, the observation of this issue from different perspectives will help to evaluate the strengths and weaknesses in this field.
Traveling abroad to get a qualified medical care has been a widespread practice for many centuries. However, today the concept of medical tourism denotes a global market with a variety of services. The leading destinations for medical travelers include Asia, India, Indonesia, Malaysia, Singapore, South Korea, Thailand, and the Philippines (Turner & Hodges, 2012, p. 11). The cost of medical services in these countries is rather low in comparison with the expensive medical procedures in the USA, the UK, France, Italy, and Japan. For instance, in India hip replacement costs approximately $9,000, while the cost of the same procedure is about $47,000 in the USA and $12,000 in the UK (Turner & Hodges, 2012, p. 10).Thus, even if to count travel costs, it is less expensive to receive medical care abroad.
Planning to travel to another country, one should know the best time of the year to go there. For example, it is better to visit India between October and March, since the period from May to September is a season of monsoon throughout the country. The best time to travel to Thailand is from November to February since this time is less rainy than the rest of the seasons in this country (Healthbase, n.d.).
People’s Expectation of Medical Tourism
The need for medical tourism lies mostly in people’s intention to get a good medical care at a lower cost. A patient-centric approach in India and Thailand gives an opportunity to use VIP facilities and services, to get one-on-one nursing care and use services of highly accessible doctors (Stolley & Watson, 2012, p. 4). In addition, in many countries patients on free government-run health care plans may wait for a year or more to receive the necessary medical procedures, while the waiting periods abroad are considerably shorter. Moreover, the medications in other countries can give the access to the treatment options, which may not be available in some countries. For instance, Stolley and Watson (2012) state that the European, Canadian, Indian, and Australian doctors have been performing hip-resurfacing surgeries since the late 1990s while the same technology in the USA did not receive approval until 2006. Another important reason to get the medical care abroad is the possibility to preserve anonymity in case of undergoing some specific procedures. Finally, medical tourism provides an opportunity to change the environment and relax from the stresses of everyday life. After the recuperation from their medical procedures, patients may combine treatment with various sightseeing tours to take advantage of the tourist attractions in their destination.
Medical Treatments in India
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The Reasons to Choose India for Medical Procedures
The years of development have made India one of the primary destinations for medical value tourism due to a number of factors that define the general quality of care. According to Services Export Promotion Council, this country has 22 Joint Commission International accredited hospitals, which employ the English-speaking personnel and use western technologies and medical protocols. The huge investments in supportive technologies and operating techniques allow performing the complicated heart, cancer, neuro, and general surgeries. India has 1.2 million Allopathic doctors, 0.17 million dental surgeons, and 2 million nurses, who generally form the largest medical personnel in South Asia (Services Export Promotion Council, n.d.). Services Export Promotion Council also states that the cost of treatment in India is from five to ten times lower in comparison with Western countries. Moreover, people do not have to wait for months or years to get a quality medical care. Finally, among the most convincing arguments in favor of treatment in India is the warmth and hospitality of its medical personnel in healthcare institutions.
Increasing Rate of Medical Tourism in India
The geographical position and the reasonable prices in India make it an ideal destination for tourists. Due to the cost effective procedures and highly qualified doctors this country occupies the second position in the global market of medical tourism (Banerjee, Nath, Dey, & Eto, 2015, p. 124). According to the statistics, this industry is worth $333 million with the growth of the number of medical tourists at the rate of 25% annually (Debata, Mahapatra, & Patnaik, 2015, p. 151). The development of medical tourism is achieved with the assistance from the side of central and state governments, private sectors, and a number of voluntary organizations.
Globalizations of Health Care System
Today, patients have access to the global market of health care services. Even a simple Internet search allows a person to find plenty of hospitals, clinics, and medical tourism companies. Their offerings often include package deals that combine medical care with air travel, ground transport, hotel accommodations, and guided tours (Turner &Hodges, 2012, p. 1). Turner and Hodges (2012) mention that Singapore and India employ national medical tourism initiatives to attract foreign investment and revenues. According to the reports from national ministries, business consulting firms, and industry groups, medical tourism is an expanding, multibillion-dollar global industry. While the world’s major economies face aging populations with increasing number of chronic diseases and high health care costs, the medical tourism industry is undergoing a period of rapid growth. Due to the accessibility of air travel and the opportunities provided by the Internet, many hospitals, clinics, and medical tourism companies can successfully promote their health services to the global clientele.
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India as a Vacation Destination
Since the inception of yoga, India has attracted international patients as a spiritual center of eastern culture. Today, it has become an exotic tourist destination, offering everything from beaches, mountains and cosmopolitan cities to picturesque villages and religious journeys to meet any taste. According to Debata, Mahapatra, and Patnaik (2015), India is unique since it offers such medical services as yoga, meditation, ayurveda, allopathy, and other medical systems that cannot be found in other countries. In addition, some foreign tourists travel to India for a specific purpose. For instance, many people consider this country to be a good place for organizing meetings and conferences. Nearly 5% of tourists visit India because of its spiritual places (Jayati & Paatlan, 2014, p. 32). Jayati and Paatlan (2014) also state that India is the second country in the world after the United Kingdom to play golf. The charm of this game and the beauty of Indian golf courses make the trip to this country a memorable one. Some travelers choose culinary tour and travel packages including a wide range of activities related to cooking, food sampling and trends, wine making and baking (Jayati & Paatlan, 2014, p. 35). Finally, India has many destinations with beautiful rivers. The connection of these places with river cruises enables India to position itself as a tourist destination with an exotic heritage.
Positive Impacts of Medical Tourism in India
The Generation of Money for the Government
The medical tourism industry has gradually become one of the primary sources of income for the economy of India. The emergence of five-star hospitals in the country attracts considerable financial investments in this field. The tendency to privatize and corporatize health care resulted in the appearance of the form of medical tourism with patients from rich areas traveling to Third World countries to receive qualified treatment, gain experience, have a chance to visit the country’s tourist attractions, as well as to use other offered resources. The results of the research by the Confederation of Indian Industry show that the income from medical tourism will have been $2.2 billion for medical institutions in India by 2021 (Aluvala & Jayaprakashnarayana, 2014, p. 5). In general, by 2017 medical tourism is expected to become a $150 billion industry in India (Stolley & Watson, 2012, p. 14).
The growth in the medical tourism sector significantly contributed to the employment generation in various activities related to this field. Investment in medical tourism can create 40 million new jobs within the next few years (Gidwani, 2013). These include employment in hospital administration, medical marketing services, international insurance, public relations, and tourism. The intention to provide tourists with the total package of healthcare and leisure services makes private sector hospitals cooperate with airlines, travel firms, hotels, car rentals, and spas. It increases the demand for travel advisors, tour planners, public relations personnel, managers, interpreters, chefs, and spa therapists. Thus, this developing industry offers great career opportunities with international options.
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Stimulation of Infrastructure Investment
In order to provide the promising future perspectives for the medical tourism sector, the Indian government has taken a number of steps to encourage foreign investment. For instance, a German company has received approval to establish a 200-bed hospital in Delhi with a foreign equity ownership of 90% (Hall, 2013, p.178). Other incentives introduced by the Indian government include easier obtainment of long-term capital for new medical resources or expansion of the existing ones, higher acceptable deprecation rate for old equipment, and decline of importation tax on life saving equipment (Hall, 2013, p.178). According to Hall (2013), Apollo Hospitals, Fortis Healthcare, and Wockhardt Hospitals represent the leading players in the private medical sector. Due to the global expansion of medical tourism, Apollo group plans to establish another 32 new hospitals in India in addition to the existing 30 medical institutions (Hall, 2013, p.178). In addition, India tries to prevent the medical personnel from residing overseas by improving and adjusting the salary rates.
The Increasing Number of Hotel and Resort Stays Due to Medical Procedure
The increasing number of medical tourists has a considerable impact on the development of hotel industry in India. Numerous hotels and resorts are bound together with leading hospitals to provide the accommodation for post treatment and to arrange rejuvenation therapy. Some medical procedures need weekly check-up, so the patients use this time mostly staying in resorts and visiting some tourist attractions in their destination. Thus, the hotels and resorts reserve rooms for the hospitals they cooperate with to ensure that all patients are accommodated. The visitors and relatives who escort the patients look for the room in the nearby hotels as well. Therefore, Star Hotels’ reports indicate the increasing number of room bookings by medical travelers, particularly in New Delhi, Chennai, Hyderabad, and Bangalore (Kumar & Raj, 2015, p. 289). Medical tourism sector development is beneficial for the three-star and four-star hotel segments. A number of resorts also report the regular profit from medical tourists due to the cooperation with hospitals.
Negative Impacts of Medical Tourism in India
Quality of Care and Accreditation Issues
Medical services in India demonstrate the lack of regulation and fragmentation because nearly 80% of healthcare services are under the control of the private sector. Thus, the quality of care provided both in private and public hospitals has become a topic of frequent discussions. There are numerous reports of medical error, medical negligence, and unsatisfactory patient safety in Indian hospitals (Ikbal, 2015, p. 1). Due to the deficient reporting systems and disclosure norms, the number of deaths because of medical errors can hardly be accounted. Therefore, the aim of hospital accreditation is to maintain the proper level of patient safety and quality.
The establishment of the National Accreditation Board for Hospitals and Healthcare Providers serves a purpose of establishing and operating accreditation program for healthcare institutions in India (Ikbal, 2015, p. 1).
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Still, there are several issues affecting the condition of healthcare in India, which demand more attention from the Accreditation Board. For instance, hospitals cannot have the ultimate control over the quality of medicines used. Consequently, the research by central drug standard control organization indicates that 0.3% of drugs in the Indian market are spurious while unofficial studies increase this percentage to 20% (Ikbal, 2015, p. 3). In addition, some experts consider that India has turned into the dumping ground for medical devices, equipment, and implants. Moreover, the period between 2011 and 2012 raised the issue of weak industrial relations in Indian hospitals due to the strikes of thousands of nurses for better pay and conditions (Ikbal, 2015, p. 3). Finally, hospitals display lack of understanding of their strengths and weaknesses, as they are not working on the constant improvement of their team.
Unregulated Growth of the Private Sector
The private healthcare sector in India is not regulated, so that there is no possibility to provide information on its facilities, which include hospitals, clinics, dispensaries, and nursing homes. As a result, the private sector controls about 2/3rd of hospitals, nearly 1/3rd of hospital beds, and approximately 75% of medical personnel across the country (Ramani, 2014, p. 17). Ramani (2014) indicates that the presence of the private sector is observed in all sub-markets as well, namely in medical technology and diagnostics, medical education and training, hospital construction and subsidiary services, pharmaceutical manufacture and sales, and the provision of treatment. However, a large number of unqualified medical workers casts doubt on the quality of provided services. The private sector’s prevalence in the medical tourism industry leads to the unequal admission to healthcare as the hospitalization of wealthy patients is six times higher than that of the poor (Ramani, 2014, p. 17).
Increased Cost of Medical Treatment
While tourists consider medical procedures in India to be considerably less expensive than in other countries, for most Indians medical care becomes ever more unaffordable due to increasing cost of treatment over the recent years. According to the research of the National Sample Survey Office, the cost of healthcare services in India increased by a double-digit amount in the first half of 2014 (Bhattacharya & Jain, 2015). The majority of patients who seek medical care in private clinics and hospitals face the problem of considerably higher costs than before. However, in spite of the fact that private medical institutions tend to overcharge the patients with unnecessary tests and procedures, they actually provide a better quality of treatment in comparison with public hospitals (Bhattacharya & Jain, 2015).
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The medical tourism industry is on a stage of development and gains an increasing popularity among the travelers worldwide. The reasons for this lie in the less expensive cost of medical procedures, and the high quality of services provided by the countries of the Third World. In addition, treatment in India meets people’s expectations in terms of the possibility to avoid long wait-time, preserve anonymity, and combine recovery with the sightseeing tours and leisure time.
Due to the increasing number of international tourists throughout the county, the medical tourism sector experiences the process of globalization and gradually becomes an international market of medical services. Its positive impact on the Indian economy results in the financial income for the hospitals and government, job opportunities for young people and medical personnel, the growing amount of infrastructure investment, and the development of the hotel and resort segments. On the other hand, the negative side of the medical tourism industry consists in the disability to control the quality of care in some institutions, the unregulated expansion of the private sector, and the increasing cost of treatment for the rural population. Thus, the conditions that are favorable for foreign tourists may be rather unacceptable for the Indian people. Nonetheless, numerous arguments in favor of medical tourism prove that this area is likely to develop and expand worldwide.